Pharmacy prior authorization

Providers are responsible for obtaining prior authorization. Providers may not bill members for services that require prior authorization and the authorization was not obtained, resulting in denial of the claim.

Authorization is not a guarantee of payment. Other limitations or requirements may apply.

Brand-name medications

To request prior authorization for brand-name medication when a generic is available, Select Health requires you to demonstrate that our member had an adverse reaction to a previously prescribed generic. You will also need to fill out a MedWatch adverse incident reporting form (PDF) and submit it to the U.S. Food and Drug Administration (FDA).

This requirement improves the safety of our members by ensuring that both Select Health and the FDA are notified of the adverse reaction. Please visit the FDA’s MedWatch page for more information and to complete submission of the form.